APSA Papers
Redilation of bowel after intestinal lengthening procedures—an indicator for poor outcome

https://doi.org/10.1016/j.jpedsurg.2010.09.084Get rights and content

Abstract

Background/Purpose

Despite a good understanding of short-term outcomes of the longitudinal intestinal lengthening and tailoring (LILT) and serial transverse enteroplasty (STEP) procedures, limited data exist on long-term complications.

Methods

This is a 15-year single-institution retrospective chart review of patients who underwent an intestinal lengthening procedure (ILP). Long-term ILP-related complications, their interval to development, patients' ability to wean off parenteral nutrition (PN), and the need for further procedures were analyzed.

Results

Of 119 patients with short bowel syndrome, 14 had undergone an ILP. Seven patients had an LILT, and 9 patients had a STEP, including repeat ILPs on the same patient. Overall, 93% of patients had complications. Four patients in the LILT group and 3 patients in the STEP group weaned off PN. Eight patients (57%) experienced bowel redilation after their ILP. The 2 deaths in the study came from this group. Seven required another abdominal operation and only one weaned off PN. There were no significant differences in mean bowel length between the redilated group and the non–re-dilated group.

Conclusions

Complications are common after ILPs, and patients who redilated their bowel after ILP did clinically worse than those who did not.

Section snippets

Methods

This is a single-institution, retrospective chart review of all patients with SBS seen at the University of Michigan who had at least one ILP done between January 1, 1995, and December 31, 2009. In this article, ILP will refer to either a LILT or STEP procedure. The following parameters were examined for each patient: type of ILP, follow-up duration, patients' ILP-related long-term complications (>2 months post-procedure), time interval to development of complications, need for and type of

Results

One hundred nineteen patients with SBS were identified, of which 14 had undergone an ILP. Seven patients (3 male, 4 female) had an LILT and 9 patients (6 males, 3 females) had a STEP. Two patients had an LILT followed by a STEP (one 5.7 years later, another 9 years later). Two patients had 2 sequential STEP procedures (one separated by 6.5 months, the other with 7-month interval). The etiologies of the patients' SBS are summarized in Table 1. The most indications for ILPs were feeding

Discussion

Intestinal lengthening procedures have generally been reported to be well tolerated and have helped improve outcomes in many patients [3], [5], [6]. A number of serious complications, however, related to both the procedure and the underlying disease process are known. One such significant complication is redilation of the operated segment of bowel, as the fundamental principles behind these ILPs is to reduce the caliber of the bowel to enable more effective transit of intestinal contents

Acknowledgments

This study was supported in part by the Center for Organogenesis teaching grant T32HD007505 (to EAM).

Cited by (0)

View full text